Was Julius Caesar's epilepsy due to neurocysticercosis?

Article (PDF Available)inTrends in Parasitology 27(9):373-4 · September 2011with2,226 Reads
DOI: 10.1016/j.pt.2011.06.001 · Source: PubMed
Letters
Was Julius Caesar’s epilepsy due to
neurocysticercosis?
Fabrizio Bruschi
Department of Experimental Pathology, M.B.I.E., Universita` di Pisa, Medical School, Via Roma, 55, 56126 Pisa Italy
It is well known that the Roman general and dictator Gaius
Julius Caesar (10044 BC) had epileptic crises. The Greek
writer Plutarch (AD 75) reported, in fact, that he was
suffering both headaches and epilepsy, whereas the Roman
historian Svetonius (119 BC) referred to him as having
excellent health; nevertheless, at the end of his life he
underwent sudden falls, and he was suffering sleep dis-
turbances.
Several epileptic crises were described for the Roman
general, the first in 46 BC in Thapsus, modern Tunisia, one
year after his first travel to Egypt, and the second referred
to by Plutarch which occurred in Cordoba, Spain, when
Caesar was over 50 years of age. After his travel back to
Rome from Egypt, two more episodes of partial crises were
described, during the assembly at the Roman Forum,
which have attracted the interest of authors of tragedies,
including Shakespeare (Julius Caesar, Act 1, Scene 2:
Casca to Brutus speaking about Caesar, ‘‘for he swounded
and fell down at it...’’ And later Casca says, ‘‘He fell down
in the market place, and foamed at mouth and was speech-
less.’’ Then Brutus stated, ‘‘Tis very like: he hath the falling
sickness’’), and screenwriters of movies and TV fiction.
Thus, the epilepsy of Caesar appeared late in his life,
suggesting an acquired rather than a congenital nature,
despite the familiarity of such crises (his son Caesarion,
born by Cleopatra VII, suffered from epilepsy since infant-
hood, as well as other descendants such as Caligula and
Britannicus).
Furthermore, epileptic crises of Julius Caesar were
described as partial at the onset, and not generalized, as
would be expected more typically in the presence of a
genetically determined epilepsy.
If the disease of Caesar was acquired, what might be the
possible causes? The Canadian neurologist McLachlan [1]
has evaluated all possible causes of acquired epilepsy.
Among the most corroborated etiological hypotheses in
the past, there were those related to chronic infectious
diseases such as neurosyphilis, in consideration of the in-
tense sexual activity of the Roman general, cerebral tuber-
culosis, typhus and malaria [1], as Julius Caesar travelled
frequently in geographical areas where he was at risk.
Another hypothesis to explain epileptic crises, in con-
sideration of the age of first manifestations, is related to a
benign tumor (meningioma or glioma) [2]. In any case,
epileptic manifestations were not accompanied by a dete-
rioration of the cognitive functions of the dictator, who was
still able to adequately carry out his functions as senator
until his murder in 44 BC. Although information on
Caesar’s life should be always evaluated with caution
because of legend aura surrounding this important histor-
ical personage, no information is available attributing his
epilepsy to other possible causes of acquired epilepsy such
as trauma or stroke. However, the head asymmetry in the
Tusculum portrait, possibly the only surviving bust of
Caesar made during his lifetime, has been interpreted
as evidence of trauma that occurred early in his life.
Finally, by exclusion, the possibility of neurocysticerco-
sis has been considered by McLachlan [1], because this
disease could be asymptomatic, for years, with the excep-
tion of crises. Neurocysticercosis is the cerebral localiza-
tion of the larval stage (cysticercus) of the human cestode
Taenia solium. At present, neurocysticercosis at a global
level represents the first cause of acquired epilepsy [3].
This hypothesis originates also because before the ap-
pearance of the well-documented comitial episodes, Julius
Caesar was travelling in Egypt where T. solium was
present at that time, as shown by the description of the
most ancient case of cysticercosis in an Egyptian mummy
of the first century BC, the so-called mummy of Narni [4].
Furthermore, Taenia spp. ova were found in the intestinal
tract of an Egyptian male buried in the first half of the
twelfth century BC [known as the mummy of Nakht, ‘the
weaver of the funerary temple of the Pharaoh Setnakht’
(11841181 BC)] [5].
The farming of swine was practiced in Hellenistic Egypt,
probably for consumption of meat, as shown in several
pictures originating from Egyptian civilization [6].The
pig was considered sacred as it represented the totem ani-
mal of Osiris; consequently, consumption of pork was for-
bidden except on the holy day dedicated to this God, when
even poor people, unable to buy pork, prepared cakes re-
sembling pigs [5].
According to McLaclan [1], Caesar might have been
infected while traveling in regions of Southern Europe
where the parasite was known to inhabit as infection in
swine was described by Aristotle’s Historia animalium.The
hypothesis of neurocysticercosis is undoubtedly intriguing,
but it is based on exclusion criteria. Unfortunately, it is
impossible to perform neuroimage analysis or serological
tests on Caesar to have a confirmation of such a diagnosis.
Acknowledgments
The Author is indebted to D. Puliga and G. Ricci for providing information
derived from classical literature.
References
1 McLachlan, R.S. (2010) Julius Caesar’s late onset epilepsy: a case of
historic proportions. Can. J. Neurol. Sci. 37, 557561
Update
Corresponding author: Bruschi, F. (fabrizio.bruschi@med.unipi.it).
373
2 Gomez, J.G. et al. (1995) Was Julius Caesar’s epilepsy due to a brain
tumor? J. Fla. Med. Assoc. 82, 199201
3 Garcia, H.H. et al. (2003) Taenia solium cysticercosis. Lancet 362,
547556
4 Bruschi, F. et al. (2006) Short report: cysticercosis in an Egyptian
mummy of the late Ptolemaic period. Am. J. Trop. Med. Hyg. 74,
598599
5 Millett, N.B. et al. (1998) ROM I: mummification for the common people.
In Mummies, Disease and Ancient Cultures (Cockburn, A. et al., eds), pp.
91105, Cambridge University Press
6 Strouhal, E. (ed.) (1992) Life of the Ancient Egyptians, University of
Oklahoma Press
1471-4922/$ see front matter ß 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.pt.2011.06.001 Trends in Parasitology, September 2011, Vol. 27, No. 9
Update
Trends in Parasitology September 2011, Vol. 27, No. 9
374
    • "The concept of adult-onset epilepsy being related to a structural disease of the nervous system can be traced back to the Hippocratic treatise " On the Sacred Disease " [5]. It has also been suggested that the epilepsy that distressed the Roman dictator Gaius Julius Cesar (100–44 BC) was related to cysticercosis, as it started when he was 54 years old (one year after one of his visits to Egypt) and were apparently of partial origin with secondary generalization [6,7]. While Egyptians did not eat pork with the exception of one sacred day per year, human taeniasis has been well documented in the ancient Egypt. "
    [Show abstract] [Hide abstract] ABSTRACT: Human taeniasis as well as porcine and human cysticercosis - caused by the pork tapeworm Taenia solium - are ancient diseases. The fact that pigs were considered impure in the ancient Greece and that the Koran prohibited the consumption of pork, were likely related to the knowledge that cysticercosis may affect swine. Evidence suggests that human cysticercosis was also present in the ancient Egypt and Rome. During the Renaissance, the causative agent was properly identified and human cases were recognized. Confirmation that both taeniasis and cysticercosis were caused by the same parasite was provided during the 19th Century by German pathologists. During the 20th Century, bouts of human cysticercosis in non-endemic regions left us valuable lessons on the mechanisms of disease acquisition and spread. These included a large series of neurocysticercosis cases in the United Kingdom that occurred after the return of troops stationed in India (which demonstrated that symptoms may occur years after infection), the epidemic of cysticercosis-related epilepsy in the Ekari people of Papua New Guinea occurring after the gift of pigs with cysticercosis received from Indonesia (demonstrating the fast establishment of endemic transmission and the impact of cysticercosis in epilepsy frequency), and the occurrence of neurocysticercosis among members of an Orthodox Jewish community of New York City, related to Latin American Taenia carriers working in their houses (highlighting the fact that cysticercosis transmission do not require the presence of infected pigs). These lessons of history have significantly contributed to our current knowledge on this disease. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Aug 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Parasitism is composed by three subsystems: the parasite, the host, and the environment. There are no organisms that cannot be parasitized. The relationship between a parasite and its host species most of the time do not result in damage or disease to the host. However, in a parasitic disease the presence of a given parasite is always necessary, at least in a given moment of the infection. Some parasite species that infect humans were inherited from pre-hominids, and were shared with other phylogenetically close host species, but other parasite species were acquired from the environment as humans evolved. Human migration spread inherited parasites throughout the globe. To recover and trace the origin and evolution of infectious diseases, paleoparasitology was created. Paleoparasitology is the study of parasites in ancient material, which provided new information on the evolution, paleoepidemiology, ecology and phylogenetics of infectious diseases.
    Full-text · Article · Sep 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Neurocysticercosis (neural infection by larvae of Taenia solium) occurs when humans become intermediate hosts of the tapeworm Taenia solium after ingesting its eggs. The disease is now the most common helminthic infection of the nervous system in humans, and its prevalence has risen significantly even in countries where it was formerly considered exotic. The introduction of modern neuroimaging and serologic techniques has improved the diagnosis of neurocysticercosis; furthermore, the development of potent cysticidal drugs has changed the prognosis of most affected patients. Nevertheless, much remains to be learned about this parasitic disease. This book provides a comprehensive and up-to-date review of the various aspects of cysticercosis of the nervous system that will be of interest to all who are involved in the care of patients with this disease. Epidemiology, neuropathology, immunopathogenesis, clinical manifestations, diagnosis, and management are all thoroughly discussed based on current evidence and practice. © Springer-Verlag Berlin Heidelberg 2014. All rights are reserved.
    Article · Oct 2013 · Arquivos de neuro-psiquiatria
Show more

    Recommended publications

    Discover more

    We use cookies to give you the best possible experience on ResearchGate. Read our cookies policy to learn more.